AAPC Codify DRG is a key feature, often referred to as the ICD-10-CM MS-DRG Grouper, within the comprehensive Codify by AAPC platform. It is designed specifically for inpatient facility coding and reimbursement, helping healthcare organizations accurately classify patient stays into Diagnosis-Related Groups (DRGs) and Multiple Severity-Diagnostic Related Groups (MS-DRGs).
The tool is built on the Inpatient Prospective Payment System (IPPS) rules and utilizes current federal guidelines to ensure compliance and accuracy. Users can input one or more ICD-10-CM diagnosis codes and applicable ICD-10-PCS procedure codes to instantly receive the resulting DRG, along with essential details like the Relative Weight, Length of Stay (LOS), Procedure Type, and Post-Acute Indication.
Key Benefits and Capabilities
- Accurate Reimbursement: Includes an integrated DRG Payment Calculator that defaults to the National Unadjusted rate but can be calibrated for any hospital in the USA using the provider number/CCN. It clearly shows all payment components (Federal Operating Payment, Indirect Medical Education Add-on, etc.) and the Billed Outlier Threshold.
- Coding Efficiency: Provides a DRG ↔ ICD-10-CM crosswalk and a Major Diagnostic Categories (MDC) look-up tool to simplify the process of crosswalking ICD-10 codes with MDCs.
- Compliance & Auditing: The tool is essential for DRG validation and auditing, ensuring that medical records are accurately reflected in diagnostic and procedure codes to secure proper reimbursement and monitor for DRG shifts that could impact the Case Mix Index (CMI).
Target users include inpatient coders, coding auditors, and financial administrators in facilities that bill for inpatient care. The tool is available as part of the higher-tier subscription to Codify by AAPC.